Differences in Clinical Characteristics of AECOPD Patients with or without Candida Isolation from the Lower...

Candida species are frequently found in the lower respiratory tract (LRT) of patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD), but the clinical significance is uncertain. This study compared the clinical differences between AECOPD patients with and without Candida in their LRT and assessed the impact on disease outcomes.

We conducted a retrospective case-control study on AECOPD patients hospitalized at the First Affiliated Hospital of Guangxi Medical University. Demographic characteristics, clinical data, and follow-up data were compared between AECOPD patients with and without Candida isolated from their LRT. Univariate and multivariate logistic regression analyses were performed to identify risk factors for AECOPD. Survival curves for the patients with and without Candida-positive LRT samples were calculated using the Kaplan-Meier method.

A total of 225 hospitalized AECOPD patients were included in the study, 88 of whom had Candida isolated from their LRT, while 137 did not. The Candida-positive group had a greater pack-year history and higher COPD Assessment Test (CAT) scores compared to the Candida-negative group. The proportion of patients with Modified Medical Research Council (mMRC) grade 4, Global Initiative for Chronic Obstructive Pulmonary Disease (GOLD) grade 4 and hospitalizations for AECOPD in the past year were higher in the Candida-positive group. Peripheral blood lymphocytes, CD8⁺ T-lymphocytes and percent predicted forced expiratory volume in 1 s (FEV₁) were significantly lower in the Candida-positive group (P < 0.05). Patients without Candida survived significantly longer than those with Candida (P < 0.001). The presence of Candida and mMRC grade 4 were independent risk factors for both acute exacerbation and hospitalization in the past year.

Positive Candida isolation and mMRC grade 4 are independent risk factors for AECOPD. Candida in the LRT of COPD patients may predict more severe clinical symptoms, greater airflow limitation, and poorer survival outcomes.